Individual
LONNIE EVERRETT JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.D.
Contact information
Practice address
1305 WHITE DR, BATESVILLE, AR 72501-9467
(870) 698-1974
(870) 698-0141
Mailing address
1305 WHITE DR, P.O. BOX 2114, BATESVILLE, AR 72501-9467
(870) 698-1974
(870) 698-0141
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD06643
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0413396
NABP#
—
Enumeration date
10/24/2006
Last updated
07/09/2007
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